Using the prevalence of perforated appendixes as an indicator of health care disparities, two Dartmouth researchers have found that patients in rural areas tend to have diminished access to health care compared to patients living in cities and suburbs.
Patients in rural areas have to travel longer to reach a hospital when they develop appendicitis, increasing the risk of a perforated appendix, Ian Paquette, chief resident in general surgery at Dartmouth-Hitchcock Medical Center and one of the authors, said in an interview with The Dartmouth. Paquette worked with DMS professor Samuel Finlayson on the study.
Patients in rural areas had a higher incidence of perforated appendixes, suggesting that their access to medical care is more limited.
Appendicitis is a useful indicator of health care disparities because the ailment exhibits similar effects in patients around the nation, follows a natural timeline and is not affected by a patient's preexisting medical conditions or medical history, Paquette said.
The condition can result in perforation or rupture of the appendix when left untreated for an extended period. The ailment is most common among patients aged 10 to 30.
Appendixes often become perforated because of patient neglect. A patient may feel pain from appendicitis but ignore it, expecting the pain to subside.
The study, presented earlier this month at the Clinical Congress of the American College of Surgeons, used discharge records of from 2003 and 2004 from a sample including 20 percent of hospitals nationwide, Paquette said. Approximately 123,000 patients were included in the study.
The team calculated that 32 percent of patients with appendicitis admitted to hospitals had a perforated appendix. Approximately 36 percent of rural patients showed a perforation, however, while only about 31 percent of urban patients did, according to the study.
Paquette and Finlayson concluded that patients from rural areas nationwide experience a higher rate of appendix perforation because of "poor access to surgical care in a timely manner," Paquette said.
Paquette said he hopes that the study will spark discussion among policy makers.
A facility like DHMC, loacted in the rural Upper Valley, can offset rural patients' distance from urban medical facilities, Joseph DeSimone, a cardiothoracic surgeon at DHMC, said in an interview with The Dartmouth.
DeSimone said that DHMC successfully balances the resources of an urban hospital with the atmosphere of a rural community. He said he chose to work at DHMC in part because he can give his patients more specialized attention.
